Chronic prostatitis Information for patients Genito Urinary Medicine page 2 of 8 Prostatitis is the term used to describe inflammation of the prostate gland. It is a fairly common condition which usually affects men between the ages of 2 and 50, although it can occur at any age. What is the prostate gland? The prostate is a gland surrounding the urethra (the water pipe) at the base of the bladder and it lies just in front of the rectum (back passage). It produces the secretions which accompany sperm to make up the semen which is released during ejaculation. What causes prostatitis In many cases no specific cause is found, but a number of factors may "trigger" the condition. Possible triggers include infection (usually a urinary tract infection), or muscle spasm in the outlet from the bladder which may allow the pressure in the prostate to rise. What is bacterial prostatitis In a small number of cases, infection in the prostate gland causes the inflammation. When identified these infections are usually with bacteria associated with cystitis, and usually cannot be transmitted to your sexual partner. This is called bacterial prostatitis. What is chronic non-bacterial prostatitis In non-bacterial prostatitis, evidence of inflammation is found on the prostate tests, but no infection is detected. Patients still experience typical symptoms. What is prostatodynia? Some men experience typical symptoms of prostatitis but there is no evidence of either inflammation of infection of the prostate gland. page 3 of 8 What is chronic pelvic pain syndrome? This is a new term that has been introduced to describe both non-bacterial prostatitis and prostatodynia. These chronic prostatitis syndromes are totally unrelated to the better-known prostate problems (prostate enlargement and prostate cancer) which usually occur in older men. What are the symptoms of prostatitis? Chronic prostatitis often causes one or more of the following symptoms: • Pain or discomfort This may be felt anywhere around the genital area, including the perineum (the area between the scrotum and the anus), testicles, penis, groin area, lower abdomen, upper thighs and back passage. The pains usually come and go, and may be dull and aching, or sharp and stabbing. • Urinary disturbances Changes which may be noticed when passing urine include passing urine more frequently than usual, difficulty in postponing urination (urgency) and noticing a poor or variable stream. Mild stinging sensations and watery discharge from the penis may also sometimes occur. • Ejaculatory disturbances Pain or discomfort may occur at the moment of ejaculation, or may occur after ejaculation and last for a period of minutes or hours. Chronic prostatitis sometimes causes the semen to change colour, or have blood in it. This is not a sign of something more serious. page 4 of 8 How long will the symptoms last? The duration and pattern of symptoms in chronic prostatitis are very variable, but the problem often persists over quite a long period of time. The symptoms generally occur in waves lasting days or weeks at a time. Gradually, the severity and frequency of the symptoms falls until the whole problem just fades away. Is there anything I can do to avoid or relieve the symptoms? Certain things seem to provoke the symptoms for some men. For example sitting for long periods of time (driving, cycling) or certain other forms of exercise. Stress can be an important factor in some cases. Occasionally alcohol (including red wine), coffee and spicy foods may bring on the symptoms. However, these things apply only to individual cases and we recommend that you simply make a mental note of anything which affects you, and then try without it for a while to see if that helps. How is prostatitis diagnosed? You will normally undergo an examination which includes: • A swab from the urethra • Urine samples • An examination of the prostate gland To examine the prostate gland the doctor needs to insert a gloved finger gently into the back passage to detect tenderness of the prostate gland and obtain secretions. Any secretions will be examined for the presence of infection or inflammation. page 5 of 8 Some blood tests may also be requested and occasionally an ultrasound examination of the urinary system (including the prostate and bladder) may be arranged. How is prostatitis treated? There is no cure which will clear up the problem overnight. Many of the treatments recommended in the past seem to help some patients, without scientific proof. The commonest treatments are: • Anti-inflammatory painkillers - such as ibuprofen (Brufen), or diclofenac (Voltarol) • Antibiotics - long courses of antibiotics (between 1 and 3 months of treatments) are rarely used to treat prostatitis. Suitable antibiotics include doxycycline of ciprofloxacin Other treatment options are usually considered in more severe or prolonged cases: • Amitriptyline (or imipramine) - this is a painkiller which in other patients and in higher dosage is sometimes used as an antidepressant • Alpha blockers - these are tablets which reduce muscular spasm in the bladder neck Other things which may help include: • Drinking plenty of water • Frequent ejaculation - thought to be beneficial as it 'flushes out' the prostate gland • Hot baths - thought to help by improving the circulation and relaxing the pelvic muscles page 6 of 8 Does prostatitis have any long term effects? Prostatitis is a great nuisance for many men, but fortunately it is not a serious disease. • There are no associations with serious underlying problems such as cancer. • Unless a sexually transmitted infection was found on your tests, you will not pass the infection to your sexual partner. • There is no good evidence that prostatitis affects fertility. It can be helpful to take a long term view of the condition. With time, most men with prostatitis find that all their symptoms gradually disappear. page 7 of 8 Produced with support from Sheffield Hospitals Charity – working hard to fund improvements that make life better for patients and their families Please donate to help us do more www.sheffieldhospitalscharity.org.uk Registered Charity No 1059043 organdonation.nhs.uk Alternative formats may be available on request. Please email: alternativeformats@sth.nhs.uk © Sheffield Teaching Hospitals NHS Foundation Trust 2013 Re-use of all or any part of this document is governed by copyright and the “Re-use of Public Sector Information Regulations 2005” SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. Email infogov@sth.nhs.uk PD4567-PIL1471 v3 Issue Date: July 2013. Review Date: July 2015